Conditioning with fludarabine and low-dose total-body irradiation before allogeneic hematopoietic cell transplantation (HCT) enabled treating older or medically infirm patients with advanced hematologic malignancies in the outpatient setting. Between December 1997 and June 2017, 1037 patients with hematologic malignancies received peripheral blood stem cell (PBSC) grafts from HLA-matched or 1 HLA antigen/allele-mismatched related or unrelated donors. Median age was 58 (range, 18 to 80) years. Serious comorbidities with Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) scores ≥3 were present in 52% of patients. We found that 47% of patients were either never hospitalized or only had an overnight hospital stay for infusion of late-arriving PBSCs while 53% were admitted for a median of 6 days. Main reasons for admission were infection, fever, graft-versus-host disease, and regimen-related toxicity. Two thirds of admissions occurred within 3 weeks of HCT. The 5-year risk of nonrelapse mortality (NRM) was 26% among hospitalized patients and 13% among nonhospitalized patients. Significant risk factors for hospitalization included unrelated transplants, 1 HLA antigen-mismatched transplant, high HCT-CI scores, and diagnosis of nonmyeloma malignancies. Significant risk factors for NRM were hospitalization, older age, unrelated transplants, and high HCT-CI scores. Ambulatory allogeneic HCT is feasible and safe.

中文翻译：

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门诊环境中的同种异体造血细胞移植。

在异基因造血细胞移植（HCT）之前使用氟达拉滨和低剂量全身照射进行条件治疗，可以在门诊治疗患有晚期血液恶性肿瘤的年龄较大或医学上较弱的患者。在1997年12月至2017年6月之间，有1037例血液系统恶性肿瘤患者接受了HLA匹配或1个HLA抗原/等位基因不匹配的相关或不相关供体的外周血干细胞（PBSC）移植。中位年龄为58岁（18至80岁）。52％的患者存在严重的合并症，造血细胞移植特异性合并症指数（HCT-CI）得分≥3。我们发现47％的患者从未输血或仅过夜住院以输注迟到的PBSC，而53％的患者中位住院时间为6天。入院的主要原因是感染，发烧，移植物抗宿主病和与治疗方案相关的毒性。三分之二的入院发生在HCT的3周内。住院患者的5年非复发死亡率（NRM）风险为26％，非住院患者为13％。住院的重要危险因素包括不相关的移植，1例HLA抗原不匹配的移植，高HCT-CI评分和非骨髓瘤恶性肿瘤的诊断。NRM的重要危险因素是住院，老年，不相关的移植和HCT-CI评分高。动态同种异体造血干细胞移植是可行且安全的。住院患者的5年非复发死亡率（NRM）风险为26％，非住院患者为13％。住院的重要危险因素包括不相关的移植，1例HLA抗原不匹配的移植，高HCT-CI评分和非骨髓瘤恶性肿瘤的诊断。NRM的重要危险因素是住院，老年，不相关的移植和HCT-CI评分高。动态同种异体造血干细胞移植是可行且安全的。住院患者的5年非复发死亡率（NRM）风险为26％，非住院患者为13％。住院的重要危险因素包括不相关的移植，1例HLA抗原不匹配的移植，高HCT-CI评分和非骨髓瘤恶性肿瘤的诊断。NRM的重要危险因素是住院，老年，不相关的移植和HCT-CI评分高。动态同种异体造血干细胞移植是可行且安全的。